Ferucarbotran-Enhanced MRI Versus Triple-Phase MDCT for the Preoperative Detection of Hepatocellular Carcinoma
Seong Hyun Kim1,2,
Dongil Choi1,
Seung Hoon Kim1,
Jae Hoon Lim1,
Won Jae Lee1,
Min Ju Kim1,
Hyo K. Lim1 and
Soon Jin Lee1
1 Department of Radiology and Center for Imaging Science, Samsung Medical
Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu,
Seoul 135-710, South Korea.
2 Department of Radiology, Wonju Christian Hospital, Wonju College of Medicine,
Yonsei University, 162 Ilsandong, Wonju, Kangwon-do 220-701, South
Korea.
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Fig. 2A. —54-year-old man with three hepatocellular carcinomas in
liver. Contrast-enhanced CT scan obtained at arterial phase shows 3.8- and
0.6-cm-diameter hypervascular hepatocellular carcinomas in liver segment VII
(arrows) and 0.5-cm-diameter hypervascular hepatocellular carcinoma
in segment VIII (arrowhead).
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Fig. 2B. —54-year-old man with three hepatocellular carcinomas in
liver. Contrast-enhanced CT scan obtained at delayed phase at same level as
A shows washout pattern in two hepatocellular carcinomas in segment VII
(arrows) and one hepatocellular carcinoma in segment VIII
(arrowhead).
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Fig. 2C. —54-year-old man with three hepatocellular carcinomas in
liver. Ferucarbotran-enhanced image from fat-suppressed, respiratory-triggered
proton density-weighted fast spin-echo MRI (TR/TE, 5,000/18) shows two
hyperintense nodules in segment VII (arrows) and one hyperintense
nodule in segment VIII (arrowhead).
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Fig. 2D. —54-year-old man with three hepatocellular carcinomas in
liver. Ferucarbotran-enhanced image from T2*-weighted fast
multiplanar gradient-recalled echo acquisition in steady state MRI (TR/TE,
130/8.4; 30° flip angle) at same level as C shows two hyperintense
nodules (arrows) in liver segment VII and one hyperintense nodule in
segment VIII (arrowhead). All three observers interpreted segment VII
and segment VIII as segments with hepatocellular carcinoma on both CT and MR
images.
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Fig. 3A. —51-year-old man with 1.2-cm-diameter hepatocellular carcinoma
in segment VIII of liver. Contrast-enhanced CT scan obtained at arterial phase
shows hypervascular nodule (arrow) in segment VIII.
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Fig. 3B. —51-year-old man with 1.2-cm-diameter hepatocellular carcinoma
in segment VIII of liver. Contrast-enhanced CT scan obtained at delayed phase
at same level as A shows hypoattenuated nodule (arrow). All
three observers interpreted this nodule as hepatocellular carcinoma.
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Fig. 3C. —51-year-old man with 1.2-cm-diameter hepatocellular carcinoma
in segment VIII of liver. Ferucarbotran-enhanced image from fat-suppressed,
respiratory-triggered T2-weighted fast spin-echo MRI (TR/TE, 4,500/98) shows
subtle hyperintense nodule (arrow) overlying vascular structure in
segment VIII.
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Fig. 3D. —51-year-old man with 1.2-cm-diameter hepatocellular carcinoma
in segment VIII of liver. Ferucarbotran-enhanced MR image from
T2*-weighted fast multiplanar gradient-recalled echo
acquisition in steady state (130/8.4; 30° flip angle) at same level as
C also shows subtle hyperintense nodule (arrow). Two of three
observers did not interpret this nodule as hepatocellular carcinoma.
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Fig. 4A. —48-year-old man with 7.2-cm-diameter hepatocellular carcinoma
in liver segment VI and false-positive lesion in segment V. Contrast-enhanced
CT scan obtained at arterial phase shows large, ill-defined, heterogeneous
enhancing mass (arrows) in segment VI and subtle enhancing nodule
(arrowheads) in segment V. Two of three observers considered nodule
in segment V to be hepatocellular carcinoma.
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Fig. 4B. —48-year-old man with 7.2-cm-diameter hepatocellular carcinoma
in liver segment VI and false-positive lesion in segment V.
Ferucarbotran-enhanced MR image from fat-suppressed, respiratory-triggered
T2-weighted fast spin-echo sequence (TR/TE, 4,500/98) at same level as
A shows no mass in segment V other than hyperintense mass
(arrows) in segment VI. None of three observers interpreted segment V
as segment with hepatocellular carcinoma.
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Fig. 5A. —45-year-old man with 2.5-cm-diameter hepatocellular carcinoma
in liver segment VI and hemangioma in segment V. Contrast-enhanced CT scan
obtained at arterial phase shows hypervascular hepatocellular carcinoma
(arrow) in segment VI and hemangioma with peripheral enhancement
(arrowhead) in segment V.
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Fig. 5B. —45-year-old man with 2.5-cm-diameter hepatocellular carcinoma
in liver segment VI and hemangioma in segment V. Contrast-enhanced CT scan
obtained at delayed phase at same level as A shows hepatocellular
carcinoma with washout (arrow) and persistent enhancing hemangioma
(arrowhead). All three observers interpreted these nodules as
hepatocellular carcinoma and hemangioma, respectively.
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Fig. 5C. —45-year-old man with 2.5-cm-diameter hepatocellular carcinoma
in liver segment VI and hemangioma in segment V. MR image from breath-hold
in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo sequence
(TR/TE, 200/4.2; 90° flip angle) before injection of contrast agent shows
nodule (arrow) in segment VI that is less hypointense than
hypointense nodule (arrowhead) in segment V.
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Fig. 5D. —45-year-old man with 2.5-cm-diameter hepatocellular carcinoma
in liver segment VI and hemangioma in segment V. Ferucarbotran-enhanced
dynamic MR images from breath-hold in-phase T1-weighted fast multiplanar
spoiled gradient-recalled echo sequence (200/4.2; 90° flip angle). Image
obtained 20 sec after injection of contrast agent (D) shows hypointense
hepatocellular carcinoma (arrow, D) and early peripheral
enhancement of hemangioma (arrowhead, D). At 1 min after
injection of contrast agent (E), image shows less hypointense nodule
(arrow, E) than in D and subsequent filling-in of
hemangioma (arrowhead, E). At 5 min after injection of
contrast agent (F), image shows hyperintense hepatocellular carcinoma
(arrow, F) and hemangioma (arrowhead, F).
Liver shows decrease in signal intensity compared with E.
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Fig. 5E. —45-year-old man with 2.5-cm-diameter hepatocellular carcinoma
in liver segment VI and hemangioma in segment V. Ferucarbotran-enhanced
dynamic MR images from breath-hold in-phase T1-weighted fast multiplanar
spoiled gradient-recalled echo sequence (200/4.2; 90° flip angle). Image
obtained 20 sec after injection of contrast agent (D) shows hypointense
hepatocellular carcinoma (arrow, D) and early peripheral
enhancement of hemangioma (arrowhead, D). At 1 min after
injection of contrast agent (E), image shows less hypointense nodule
(arrow, E) than in D and subsequent filling-in of
hemangioma (arrowhead, E). At 5 min after injection of
contrast agent (F), image shows hyperintense hepatocellular carcinoma
(arrow, F) and hemangioma (arrowhead, F).
Liver shows decrease in signal intensity compared with E.
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Fig. 5F. —45-year-old man with 2.5-cm-diameter hepatocellular carcinoma
in liver segment VI and hemangioma in segment V. Ferucarbotran-enhanced
dynamic MR images from breath-hold in-phase T1-weighted fast multiplanar
spoiled gradient-recalled echo sequence (200/4.2; 90° flip angle). Image
obtained 20 sec after injection of contrast agent (D) shows hypointense
hepatocellular carcinoma (arrow, D) and early peripheral
enhancement of hemangioma (arrowhead, D). At 1 min after
injection of contrast agent (E), image shows less hypointense nodule
(arrow, E) than in D and subsequent filling-in of
hemangioma (arrowhead, E). At 5 min after injection of
contrast agent (F), image shows hyperintense hepatocellular carcinoma
(arrow, F) and hemangioma (arrowhead, F).
Liver shows decrease in signal intensity compared with E.
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Copyright © 2005 by the American Roentgen Ray Society.
) and ferucarbotran-enhanced MRI (
) calculated with mean
values from all three observers. Mean values for area under the curve
(Az) (an indicator of diagnostic accuracy) for detection
of hepatocellular carcinoma on ferucarbotran-enhanced MRI and triple-phase
MDCT were 0.947 ± 0.010 and 0.949 ± 0.010, respectively.
Difference in mean Az values between the two techniques
was not statistically significant (p = 0.799).